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House Call: Examining Irritable Bowel Syndrome

Kale is among the foods that can be good for people who have Irritable Bowel Syndrome. (Adriana Janovich / The Spokesman-Review)
Kale is among the foods that can be good for people who have Irritable Bowel Syndrome. (Adriana Janovich / The Spokesman-Review)
By Dr. Bob Riggs and M.D. For The Spokesman-Review

Irritable Bowel Syndrome is a functional disorder of the gastrointestinal tract, likely involving the nerves and microorganisms of the entire GI tract. The symptoms include cramping, abdominal pain, bloating, gas and diarrhea or constipation (or both); however, to date no structural or biochemical abnormalities have been found that would explain the cause of this disorder. Common triggers are food, stress and hormones.

Some conditions have similar symptoms to IBS and can be very serious, so see your health care provider if you have any of the following:

Weight loss

Diarrhea that awakens you in the night

Rectal bleeding or blood in your stool

Unexplained vomiting

Difficulty swallowing

Worldwide, about 10 to 15 percent of people are affected by IBS and 60 to 65 percent of those are female. Most people have mild (40 percent) or moderate (35 percent) IBS. The good news is that with treatment and lifestyle changes, most cases of IBS can be managed successfully so that it interferes minimally with your life. Sometimes symptoms can go away completely. Because there is no test for IBS, your medical provider will work to rule out other conditions before making that diagnosis.

Treating IBS is often most successful when a multifaceted approach is taken. Many patients find that learning how to better manage stress can prevent or lessen symptoms. Some ways of doing this include counseling, biofeedback, progressive relaxation exercises and mindfulness training. You may have other ideas of how to manage your stress, and if you try them and they help relieve your IBS, then keep doing what you’re doing.

Changing what you eat can also reduce IBS symptoms over time. I recommend keeping a food and symptom diary for a couple of weeks to help you determine what foods may be triggering your IBS and then eliminating them from your diet. If you are improved and there is something on that list that you really enjoy you can try reintroducing suspected culprits one at a time to get more specific about what foods you need to avoid. Most people find that eating high fiber foods and drinking plenty of fluids helps as well, although some types of fiber are better tolerated than others.

An effective diet change is what is called a low FODMAP diet. FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are basically sugars that are not well digested by humans and that pass through and are broken down by gut bacteria. The products of that bacterial digestion cause discomfort for people with IBS although it is a normal part of digestion. Many people with IBS feel better if they reduce the foods high in these sugars. The list is long but examples of food high in these are garlic, onions, beets, and bananas. Low FODMAP foods include broccoli, kale, and carrots. If you are interested in trying this approach there are many lists available online or through your medical provider.

Other lifestyle changes that can be helpful include eating at regular times, eating smaller but more frequent meals, slowly increasing the amount of fiber in your diet, and regular exercise.

Depending on your symptoms, their severity and your triggers, your medical provider may suggest fiber supplements or laxatives and is some cases medication.

With attentive care from your health care providers and some work on your part, your quality of life can improve significantly and you can participate in the activities and events that you may have been avoiding because of your symptoms.

Bob Riggs is a family medicine physician practicing at Kaiser Permanente’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.

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